针刀治疗对腰椎间盘突出症腰背伸肌康复的影响研究

Effects of Acupotomy on Lumbar Back Extensor Rehabilitation in Patients with Lumbar Disc Herniation

目的:探究针刀对腰椎间盘突出症腰背伸肌康复影响性。方法:选取2017年3月至2018年2月新疆医科大学第二附属医院收治的腰椎间盘突出症患者94例作为研究对象,按照就诊顺序编号随机分为对照组与观察组,每组47例。对照组予牵引、药物治疗、物理因子治疗、推拿、运动治疗,观察组在对照组基础上加用针刀治疗,2组患者均治疗2周。观察2组患者治疗前、完成治疗后在腰背伸肌指标峰力矩(PT)、力矩加速能(TAE)、最大单次作功量(TW)、平均功率(AP)、屈肌/伸肌峰力矩比值(F/E)变化并比较;观察2组患者治疗前、完成治疗后腰背伸肌疲劳程度和肌力表面肌电指标平均功率频率(MPF)和积分肌电(IEMG)变化并比较;观察2组患者治疗前、完成治疗后在疼痛视觉模拟评分(VAS评分)、日本骨科协会评分(JOA评分)、日常生活活动能力量表(Barthel指数)、腰椎前屈后伸关节活动度变化并比较;总结完成治疗2组患者疗效情况。结果:1)2组患者治疗前左侧MPF、IEMG,右侧MPF、IEMG比较,差异无统计学意义(P>0.05),完成治疗后2组患者左侧MPF、IEMG,右侧MPF、IEMG水平较治疗前均显著升高,差异有统计学意义(P<0.05),完成治疗后观察组左侧MPF、IEMG,右侧MPF、IEMG均高于对照组(P<0.05)。2)2组患者治疗前30°、90°的PT、TAE、TW、AP、F/E比较,差异无统计学意义(P>0.05),完成治疗后2组患者30°和90°的PT、TAE、TW、AP水平较治疗前均显著下降、F/E较治疗前均显著升高,比较有统计学意义(P<0.05),完成治疗后观察组30°和90°的PT、TAE、TW、AP水平均低于对照组,30°和90°的F/E均高于对照组(P<0.05)。3)2组患者治疗前VAS评分、JOA评分、Barthel指数、腰椎前屈后伸关节活动度比较,差异无统计学意义(P>0.05),完成治疗后2组患者VAS评分较治疗前均显著下降、JOA评分、Barthel指数、腰椎前屈后伸关节活动度较治疗前均显著升高,比较有统计学意义(P<0.05),完成治疗后观察组JOA评分、Barthel指数、腰椎前屈后伸关节活动度高于对照组,VAS评分则低于对照组(P<0.05)。4)完成治疗后观察组患者治愈率、总有效率明显高于对照组(P<0.05)。结论:针刀治疗能改善腰椎间盘突出症腰背伸肌功能,能改善症状,提高疗效。

Objective:To explore the effects of acupotomy on rehabilitation of lumbar intervertebral disc protrusion.Methods:From March 2017 to February 2018,94 patients with lumbar disc herniation in The Second Affiliated Hospital of Xinjiang Medical University were randomly divided into a control group(47 cases)and an observation group(47 cases)according to the order of visiting.The control group was treated with traction,drug therapy,physical factor therapy,massage and exercise therapy,while the observation group was treated with acupotomy on the basis of the control group.Both groups were treated for 2 weeks.The changes of peak torque(PT),torque acceleration energy(TAE),maximum single work(TW),average power(AP),flexor/extensor peak torque ratio(F/E)before and after treatment were observed and compared between the 2 groups.The changes of mean power frequency(MPF)and integral electromyography(IEMG)were compared,and the changes of visual analogue score(VAS),Japanese Orthopedic Association score(JOA),activity of daily living scale(Barthel index)and extensor joint activity before and after treatment were observed and compared.The curative effect of the 2 groups was concluded after treatment.Results:There was no significant difference in left MPF,IEMG,right MPF and IEMG between the 2 groups before treatment(P>0.05).After treatment,the levels of left MPF,IEMG,right MPF and IEMG in the 2 groups were significantly increased than those before treatment,and the difference was statistically significant(P<0.05).The levels of MPF and IEMG were higher in the observation group than those in the control group(P<0.05).2)There was no significant difference in the levels of PT,TAE,TW,AP and F/E at 30°and 90°between the 2 groups before treatment(P>0.05).After treatment,the levels of PT,TAE,TW and AP in the 2 groups at 30 and 90 degrees decreased significantly,while F/E increased significantly(P<0.05).The levels of PT,TAE,TW and AP at 30 and 90 degrees were lower than those in the control group,and the F/E at 30 and 90 degrees were higher than those in the control group(P<0.05).3)There was no significant difference in VAS score,JOA score,Barthel index and lumbar flexion and extension joint activity between the 2 groups before treatment(P>0.05).After treatment,the VAS score of the 2 groups decreased significantly,JOA score,Barthel index,lumbar flexion and extension joint activity increased significantly.The difference was statistically significant(P<0.05).After treatment,the JOA score,Barthel index,lumbar flexion and extension joint activity in the observation group were higher than those in the control group,while the VAS score was lower than that in the control group(P<0.05).4)After treatment,the cure rate and total effective rate of the observation group were significantly higher than those of the control group(P<0.05).Conclusion:Acupotomy can improve the function of lumbar dorsal extensor,improve the symptoms and improve the curative effect of lumbar disc herniation.